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EMS for children with special needs

EMS for children with special needs. Carlos Villavicencio, MD, FAAP Clinical Assistant Professor, UW School of Medicine EMS Conference, February 4, 2011. Disclosures. I have no financial conflicts of interest I have a son with CP. Objectives.

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EMS for children with special needs

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  1. EMS for children with special needs Carlos Villavicencio, MD, FAAP Clinical Assistant Professor, UW School of Medicine EMS Conference, February 4, 2011

  2. Disclosures • I have no financial conflicts of interest • I have a son with CP

  3. Objectives • At the end of the presentation, participants should: • Recognize unique challenges in kids with special needs • Recognize common challenges in kids with special needs • Understand utility and layout of Emergency Information Form (EIF) • Recognize some unique situations and how to address them clinically

  4. Definitions • Who are children with special needs? • Diagnoses • CP Seizures • CLD or Asthma • Muscular Dystrophy

  5. Definitions • Devices • Ventilators Feeding tubes Cincinnatichildrens.org VP shunt Blogs.naver.com/youjinch Cincinnatichildrens.org O2 www.articles.complexchild.com

  6. Definitions • Who are children with special needs? • Special Needs: • Medications • Complex Management Plans • Particularly vulnerable and prone to complications

  7. Some General Statistics www.cartoonstock.com

  8. Seeking Emergency Care • Age distribution Prehospital Emergency Care 2000; 4:19-23

  9. Seeking Emergency Care • Related or unrelated to underlying condition? Prehospital Emergency Care 2000; 4:19-23

  10. Seeking Emergency Care • Related or unrelated – by diagnosis Prehospital Emergency Care 2000; 4:19-23

  11. Most Common Interventions • Related Unrelated C-collar O2 O2 C-collar Glucose (IV or PO) Wounds / Fractures Glucose Wounds Peripheral IV Peripheral IV Albuterol Albuterol

  12. www.demotination.com

  13. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  14. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  15. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  16. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  17. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  18. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  19. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  20. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  21. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  22. Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc

  23. Specific Conditions www.legacystation.com

  24. Specific Conditions: Tracheostomies • Focus on chronic tracheostomy • Indications: • Upper airway obstruction • Pierre-Robin (congenital) vs. Acquired • Chronic mechanical ventilation • Inability to clear secretions • Neuromuscular disease

  25. Specific Conditions: Tracheostomies Cuffed Cuffless http://commons.wikimedia.org

  26. Specific Conditions: Tracheostomies • Obstruction • Attempt suctioning using largest diameter possible for < 5 sec • If still obstructed, urgently replace with new cannula

  27. Tracheostomy sizing chart

  28. Tracheostomy sizing chart

  29. Replacing a Tracheostomy Tube - Video http://www.tracheostomy.com

  30. Specific Conditions: Replacing a Tracheostomy • Steps: • 1 Remove inner cannula • 2 Insert obturator • 3 Extend patient’s neck using shoulder roll • 4 Insert tube into stoma in smooth, curved motion. No resistance should be felt. If excessive force used, can cause false track • 5 Remove obturator • 6 Confirm position, inflate cuffed tubes

  31. Specific Conditions • Gastrostomy Tubes http://tofs.org.uk

  32. Complication: Gastrostomy tube dislodged • Key emergency action: • Can replace with foley • Use same size or 1 smaller • Don’t inflate balloon if <8wks from placement

  33. Specific Conditions • Cerebrospinal fluid shunts • Most common is VPS • Also VAS neuroanimations.com neuroanimations.com

  34. Complication • Clinical scenario: • 4yo with shunt due to IVH as preemie now with 2 days of headache, vomiting • Afebrile, decreased oral intake. • Drowsy but arousable. Downward gaze. Moving all extremities equally

  35. Complication: VPS Malfunction • Key emergency action: • Evaluation of shunt, assessment by neurosurgeon • Most predictive? • Vomiting • Lack of fever • Parental suspicion • Typical pattern for given child

  36. Questions?

  37. Examples

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